Is radiation of full breast really necessary?

adina65

Hi, I guess I'll jump right in. I'm a 65 year old female diagnosed in November with stageIIB low grade right breast, ER+PR+ HR2-. Had bilateral mastectomy my choice, 9 nodes taken,1 auxiliary node found + with cancer cells bursting through, so to say the least , it's probably in my lymphatic system. Conference with oncologist and had Oncotype DX score of 21. With all factors considered after reading my pathology he said no chemo but sent me to a radiation oncologist. After conferring with her she wants to do a full breast radiation also targeting the area of the node near upper area for 5 1/2 weeks, every day (28) treatments. Of course I don't want this but my statistics that she gave me were 15% chance of reoccurrence in 10years without radiation and 8% chance of reoccurrence with radiation. Not very good percentages,but I have to do something. My question is has anyone ever done PROTON THERAPY for this and I also want to hear from women that have had full breast radiation and what their on going sysmptons have been.

ChiSandy

As I understand it (I may be wrong), proton therapy is used neoadjuvantly to shrink or destroy an existing tumor--it is very powerful and needs to be precisely directed. Partial-breast radiation is usually for a small node-negative stage 1 Luminal A (ER+/PR+/HER2-, grade 1 or 2), after lumpectomy with clean margins in women past age 60. Your RO probably wants to guard against the possibility that not only is there cancer in the node and lymph vessels but also perhaps in any tissue remaining (skin, chest wall, muscle) after mastectomy. But without an exact location of confirmed intact tumors, the boat has already sailed on proton therapy (or partial-breast radiation if there is no tumor cavity). You will likely be advised also to take an aromatase inhibitor to deprive any remaining cells of estrogen, because your cancer was hormone-positive.

adina65

Oh Sandi, Thank you so much for at least giving an opinion that I can write down and present back to #1 the radiation Oncologist and #2, the Oncologist that I see at Scripps for my 2nd opinion for Proton Therapy. Yes, I do have to take Femara after treatment with radiation if I decide to go that route. The reason I'm looking not Proton therapy is because there have been some new advances, but as you said I won't know the answer until I can meet directly with the doctor and after he has read my pathology report. Thank you again

ShetlandPony

I considered participating in a trial that used proton therapy instead of standard whole breast radiation using photons, after lumpectomy. I learned that protons are just as effective as photons, but that the proton therapy would be a partial breast treatment. The skin effects were expected to be similar, but over a smaller area. So the question may be, are you a good candidate for partial?

ayr1016

I spoke with the local proton therapy center in my area and they told me that they only do it on women who qualify. I did not ask for more specifics after that. But, what I gathered was that the area was going to be very small/precise (not full breast). The expense is huge, so an insurance company is likely to deny it since RADS are cheaper. My MO and RO want to do full breast, as Sandy said, to get any strays that have broke off from the tumor and are looming around the breast tissue. Interestingly enough, both my MO and RO are fans of the proton therapy. But, $$ wise and coverage (small area vs full breast) they did not feel I was right for it.

adina65

yes, I had my consultation last week and the Oncologist said he could do whole breast or just the lymphatic area. Since I've already had a bi-lateral mastectomy I'm going to opt for the lymphatic area only. Good luck and post when you get your opinion.